At 8:00 a.m. on June 11, 2019, physicians from three Chinese hospitals, including the First Affiliated Hospital of China Medical University, and a top expert at the Dana-Farber Cancer Institute discussed adjuvant and neoadjuvant chemotherapy for early-stage breast cancer by Medebound HEALTH telehealth video platform, which was a great success.
With the assistance of Medebound HEALTH, Dr. Eric. P. Winer, Chief Strategy Officer of Dana-Farber Cancer Institute, and the First Affiliated Hospital of China Medical University, the Second Hospital of Dalian Medical University, and the First Affiliated Hospital of Jinzhou Medical University had a friendly and fruitful discussion on adjuvant and neoadjuvant chemotherapy for several early-stage breast cancer patients by remote video.
U.S. participating expert
Eric P. Winer, MD
Director of Breast Cancer Center, Dana-Farber Cancer Institute
Chief Strategy Officer, Dana-Farber Cancer Institute
Dr. Winer received his M.D. degree from Yale University in 1983 and completed his internal medicine training at Yale-New Haven Hospital, where he served as chief resident. Then he completed his specialist training in the Hematology and Oncology Department of Duke University Medical Center. From 1989 to 1997, Dr. Winer served as head of the multidisciplinary breast program at Duke University Hospital. In 1997, Dr. Winer joined Brigham and Women's Hospital/Dana-Farber Cancer Institute as director of the Breast Cancer Center and currently serves as chief strategy officer, chief of the Women's Cancer Division, director of the Breast Oncology Center of the Susan F. Smith Women's Cancer Center, and chairman of the Thompson Breast Cancer Research, etc.
Founded in 1947, Dana-Farber Cancer Institute is a cancer hospital affiliated with Harvard Medical School and a federally designated comprehensive cancer center, which is committed to providing cancer patients with professional and best medical care, as well as improving the understanding, diagnosis, chemotherapy and prevention of cancer and related diseases through cutting-edge research.
The Institute is a world leader in the clinical areas of cancer gene location therapy, cancer immunotherapy, cancer endocrine therapy, and cancer biotherapy and cancer vaccines, with more than 700 clinical trials available each year. Dana-Farber/Brigham Cancer Center is jointly established by Brigham and Women's Hospital and Dana-Farber Cancer Institute, which is ranked as one of the top and most authoritative cancer centers in the United States.
Chinese participating experts
•Professor Jin Feng and Professor Teng Yue'e, the First Hospital of China Medical University
•Professor Li Man, the Second Hospital of Dalian Medical University
•Professor Li Jincheng, the First Affiliated Hospital of Jinzhou Medical University
The First Hospital of China Medical University
The Second Hospital of Dalian Medical University
The First Affiliated Hospital of Jinzhou Medical University
Medebound HEALTH successfully facilitated this telecommunication, oncologists from four places in China and the U.S. communicated in real time through the online platform and discussed adjuvant and neoadjuvant chemotherapy for patients with early-stage breast cancer.
Summary of the consultation
At the beginning of the consultation, Chinese participating experts gave opening words and co-hosted the consultation with Medebound HEALTH.
Then, Harvard Professor Eric P. Winer, MD gave a detailed presentation on Adjuvant and Neoadjuvant Chemotherapy for Patients with Early-stage Breast Cancer: Therapeutic Principles and Practical Reflections:
•Adjuvant and neoadjuvant chemotherapy for patients with early-stage breast cancer, both with comparable survival time
•In general, most patients with stage I and some patients with stage II ER+/HER- breast cancer should undergo surgery first
•For individual patients, pathologic complete response (PCR) is a strong predictor and a surrogate measure for long-term survival benefit
•In the neoadjuvant chemotherapy, new approaches to escalation and deescalation may enter the clinic, and future clinical trials may be conducted mainly in small samples and based on biological features of patient.
After Professor Eric P. Winer's presentation, the experts all expressed they had learned a lot and gave their opinions and questions on the contents of Adjuvant and Neoadjuvant Chemotherapy for Patients with Early-stage Breast Cancer: Therapeutic Principles and Practical Reflections, followed by a heated discussion with Professor Eric P. Winer.
Q&A
Question: How should PCR be assessed in neoadjuvant chemotherapy and how can high PCR rates be achieved?
Answer: Patients may improve their prognosis with neoadjuvant chemotherapy that has a high expected PCR rate. With regard to neoadjuvant chemotherapy for patients with triple negative breast cancer and HER2-positive breast cancer, intensive adjuvant chemotherapy may be used to improve prognosis if PCR is not achieved. Ultrasound, breast X-ray and breast magnetic resonance imaging are recommended for evaluation before and after neoadjuvant chemotherapy.
Question: How to choose the adjuvant chemotherapy strategy for breast cancer patients who undergo radical resection after local recurrence?
Answer: Breast cancer patients undergo secondary radical surgery after local recurrence, and subsequent replication of chemotherapy should depend on the subtype of cancer and the duration of recurrence. Adjuvant chemotherapy should be recommended for patients with isolated local recurrence of completely resected breast cancer, especially if the recurrent tumor is estrogen receptor negative and the recurrent time interval is long.
What is the subsequent local recurrence chemotherapy strategy of neoadjuvant treatment with targeted combined chemotherapy for breast cancer?
The PCR rate have multiplied after neoadjuvant chemotherapy combined with targeted for HER-2 positive breast cancer. If the patient has subsequent local recurrence with tumor >3cm, surgery may be chosen.
The consultation came to an end in a friendly atmosphere. The participating doctors unanimously praised the effectiveness of the online discussion and have been eager to apply the practical experience based on this communication to explore a path to cure patients with early-stage breast cancer.
Medebound HEALTH cross-border telehealth platform makes consulting a US-based cancer doctor online convenient, fast, and easy. Patients can be assisted by both local top experts as well as top cancer specialists and oncologists from the most elite cancer hospitals in the United States without having to travel.
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